Associated vessel heteromorphosis in laparoscopic complete mesocolic excision and solutions to intraoperative hemorrhage / 中华胃肠外科杂志

Vessel identification and dissection are the key processes of laparoscopic complete mesocolic excision (CME). Vascular injury will lead to complications such as prolonged operative time, intraoperative hemorrhage and ischemia of anastomotic stoma. Superior mesenteric artery (SMA), superior mesenteric vein(SMV), gastrointestinal trunk, left colic artery(LCA), sigmoid artery and marginal vessels in the mesentery have been found with possibility of heteromorphosis, which requires better operative techniques. Surgeons should recognize those vessel heteromorphosis carefully during operations and adjust strategies to avoid intraoperative hemorrhage. Preoperative abdominal computed tomography angiography(CTA) with three-dimensional reconstruction can find vessel heteromorphosis within surgical area before operation. Adequate dissection of veins instead of violent separation will decrease intraoperative bleeding and be helpful for dealing with the potential hemorrhage. When intraoperative hemorrhage occurs, surgeons need to control the bleeding by simple compression or vascular clips depending on the different situations. When the bleeding can not be stopped by laparoscopic operation, surgeons should turn to open surgery without hesitation.

Application of Berg Balance Scale, Mini-Balance Evaluation Systems Test and Brief-Balance Evaluation Systems Test for Falls in Chronic Obstructive Pulmonary Disease Patients / 中国康复理论与实践

@#Objective To compare the differentiating effect of Berg Balance Scale (BBS), Mini-Balance Evaluation Systems Test (Mini-BESTest) and Brief-BESTest on the risk of falls in chronic obstructive pulmonary disease (COPD) patients. Methods From September, 2016 to March, 2017, 22 COPD patients with history of falls and other age-matched 66 COPD patients without history of falls were assessed with BBS, Mini-BESTest and Brief-BESTest. The data were compared with paired Logistic regression, Log-likelihood estimate, and the skewness coefficient were calculated. Results BBS, Mini-BESTest and Brief-BESTest all were valuable for differentiating the risk of falls in COPD patients. Log-likelihood estimate value was the least in Brif-BESTest (5.372), followed with Mini-BESTest (12.918) and BBS (17.644). There was not a ceiling effect in Brief-BESTest and Mini-BESTest, but there was in BBS. Conclusion All the BBS, Mini-BESTest and Brief-BESTest can predict the risk of falls in patients with COPD, and Brief-BESTest is the most predictive. There is a ceiling effect in BBS for COPD patients, but not in Brief-BESTest and Mini-BESTest.

Quality control of laparoscopic colorectal surgery / 中华胃肠外科杂志

Total mesorectal excision(TME) has become the standardized modality in rectal cancer surgery. The strict quality control of surgery has been introduced. The improvement of surgery quality resulted in the decrease of local recurrence rate and the increase of survival rate. TME becomes the model that quality control of surgery improved outcomes. In view of this, in recent years, complete mesocolic excision (CME) and extralevator abdominoperineal excision (ELAPE) have been established as the corresponding standardized procedures, which shows the preliminary clinical effects. Utilization of laparoscopic surgery for management of colorectal cancer has been widely accepted. Laparoscopic TME and CME will further improve the overall outcomes of colorectal cancer.

Factors about the feasibility of local excision of low rectal cancer / 肿瘤研究与临床

Objective To investigate the prognosis of local resection in patients with low rectal cancer, and assess surgical indications for this procedure. Methods One hundred and twenty-four patients with low rectal cancer from Jan 1975 to Dec 2006 were analyzed, the clinicopathologic features and surgical, outcome were examined as prognostic factors. Survival rate was estimated by Kaplan-Meier method and compared by Log-Rank test, prognostic factors were analyzed by multivariate COX proportional hazards model. Results The 5-year survival rate of 124 patients underwent local resection was 90.7 %(97/107), there were 4.8 %(6/124) patients with complications and 15.3 %(19/24) ones with local recurrence.The infiltration, vascular invasion, the size of tumor and the histological grade were significant prognostic factors of overall survival, but gender, age, the tumor site and the macroscopic type were not. Multivariate analysis indicated that the tumor infiltration were independent poor prognostic factor. Conclusion Local resection is suitable for Tis and T1 low rectal cancer, and those with high local recurrence factors should undergo radical resection. Strict follow-up and adjuvant therapy is necessary for local excision.